This resubmitted proposal responds to PA-12-252 (NIOSH Exploratory/Developmental Research Grant Program), is aligned with NORA Activity/Output Goal 2.1.1 (Evaluate the effectiveness of legislative mandates for safe patient handling in hospitals, long-term care and home healthcare. (p. 12)), and focuses on NORA Sector: Healthcare and Social Assistance Sector. In 2012, Nursing homes (NH) were noted as the most dangerous workplaces in the country. Since 2005, nine states have enacted safe patient handling legislation in NHs (Hawaii, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, and Texas). Despite the cost of NH worker injuries and the toll on a workforce characterized by high turnover, no national studies have evaluated whether legislation reduces NH worker injuries, and for which NHs this approach is effective. This proposed R21 is a first step toward estimating the effect of state-level safe handling legislation on reducing the rate of worker injuries and is closely aligned with NORA priorities. We propose developing a novel national data source spanning 10 years which merges facility level worker injury rates collected on the OSHA Data Initiative, resident level information from the Minimum Data Set (MDS), facility level information captured by the Certification and Survey Provider Enhanced Reporting (CASPER) system, and area level information provided by the Area Health Resource File. The rich MDS data source provides information on resident weight and levels of dependency which are important predictors of worker injury. CASPER provides key details on staffing resources, ownership, and market characteristics. We propose the use of advanced statistical techniques to evaluate the quasi-experimental study design. Specific aims include testing the independent effects of state-level patient handling legislation on reducing worker injuries in NHs, and characterizing NH market and organizational characteristics associated with NHs whose NH worker injury rates declined in the wake of legislation. We hypothesize that reductions in worker injuries will occur in some, but not all NHs, and that we will be able to profile NHs for whom legislation is and is not an effective strategy for NH worker injury reduction. R2P deliverables will include foundational evidence-based manuscripts, policy briefs, and tool kits available to state and federal governments to inform future regulation and legislative initiatives and to nursing home administrators for internal safety improvements aimed at reducing staff injuries.